Anesthetic reporting in stroke thrombectomy randomized clinical trials: a systematic review

Area of Science:

• Neurology
• Anesthesiology
• Clinical Trials

Background:

• Mechanical thrombectomy (MT) is a key treatment for acute ischemic stroke (AIS).
• The level of detail regarding anesthesia care in randomized clinical trials (RCTs) for MT in AIS is not well understood.
• The 2014 Society for Neuroscience in Anesthesiology and Critical Care (SNACC) guidelines aimed to improve endovascular thrombectomy care.

Purpose of the Study:

• To systematically review and elucidate the reporting quality of anesthesia care in RCTs of MT for AIS.
• To assess the impact of the SNACC guidelines on the reporting of anesthesia and monitoring details.
• To identify areas for improvement in future RCT design for MT in AIS.

Main Methods:

• A systematic review of RCTs published between January 1, 2004, and December 31, 2024, was conducted.
• A scoring system was developed to evaluate the reporting of demographic, essential monitoring, anesthetic care, and MT outcome elements.
• Data were compared before and after the publication of the 2014 SNACC guidelines.

Main Results:

• Of the 77 included studies, reporting of anesthesia elements was minimal (0% for essential monitoring, 0% for anesthesia care).
• Demographics were reported in 77.8% of trials, and outcomes in 60%.
• Inclusion of an anesthesiologist as an author significantly improved reporting scores for essential monitoring (42% vs. 0%) and anesthesia (42% vs. 0%).

Conclusions:

• Anesthesia and physiological details are inadequately reported in current MT RCTs for AIS.
• The inclusion of anesthesiologists in trial authorship is associated with improved reporting standards.
• Future RCTs investigating MT for AIS should prioritize the inclusion and detailed reporting of anesthesia-related information.